Although significant strides have been made worldwide in terms of screening, diagnosis and treatment of various diseases, the burden of disease is still huge with low-income settings being disproportionately affected.
According to a 2018 research study titled: “The Status of Health Promotion in Botswana”, authored by Roy Tapera, Sekis Moseki and James January, the realisation that low-income settings are disproportionately affected calls for “an urgent need to shift focus from solely pursuing medical interventions but to also tackle social and environmental determinants of health”.
In terms of the World Health Organization (WHO), health promotion is a process of enabling people to increase control over, and to improve, their health. Thus, health promotion as a discipline seeks to address social issues outside of the bio-medical approach.
The Ottawa Charter on health promotion seeks to enhance health and well-being of populations through building healthy public policies, reorientation of health services, creating supportive environments, strengthening community action and developing personal skills.
The health system in Botswana is delivered through a decentralised model with primary health care being the pillar of delivery system. The research study acknowledges that Botswana has an extensive network of health facilities (hospitals, clinics, health posts and mobile stops) in the 27 health districts.
Public sector health care services are almost free for citizens whilst foreigners pay a subsidised fee. Primary health care services in the country have been integrated within the overall hospital and health care services, and are provided in the respective out patients departments of hospitals.
The government through the Ministry of Health and Wellness is the principal health care provider and the ministry is responsible for the national health including policies, goals and strategies for health development and delivery.
Hospital care, medications, and laboratory tests are done free for all citizens in public sector facilities and each health district, led by a public health specialist has an average of three or more posts for health promotion officers depending on the size of the district.
At the lowest level Botswana has health education assistants whose duties are to deliver basic health care guidance and health education information to homes and communities, to save lives through strengthening health-community linkages, improving health outreach to the hard to reach and upscaling of the implementation of high impact interventions.
According to the research study, health education and promotion programmes are coordinated by the health promotion unit at national level under the department of public health in the Ministry of Health and Wellness.
Created in 1988, the department of health education and promotion’s mandate includes among others the coordination of the development and implementation of the health promotion and education policies, guidelines, legislation, regulations, standards and strategies relevant for public health.
It is noted by the research that the Ministry of Health and Wellness through the Health Education Unit has taken steps towards the prevention and control of non-communicable diseases. Various communication channels among others radio, and television are being used to sensitize positive eating habits and the importance of physical exercise.
HIV/AIDS and tuberculosis are of paramount importance when it comes to health promotion response to public health. Behaviour Change Communication Unit within the Department of HIV/AIDS Prevention and Care is composed of ten health promotion officers who are assigned to programmes such PMTCT, ARVs, and Counseling and Testing, STI unit, Safe Male Circumcision, TB/HIV/AIDS and Home-Based Care Unit.
Health education assistants are also part of the health education cadres attached to all health facilities in the country to focus mainly on health education at grassroots level. One of the primary health care services that the education assistants offer is nutritional surveillance and growing monitoring of all under five children and report to the district health education office. As a way of strengthening child welfare services, growth monitoring and promotion policy and feeding policy for under fives have been developed.
Through the Department of Public Health, the ministry conducts malaria campaigns every year particularly on the northern part of Botswana where cases of malaria escalate during rainy seasons.
Health promoters in malaria zones play a vital role of intensifying health information campaigns on prevention and convincing community members to allow spraying teams to have access in to their homes. They also educate and demonstrate the use of mosquito nets.
The study observes further that there have been sporadic outbreaks of measles and diarrhea among under-fives and in schools. Every year the district management health teams embark on national campaign on Vitamin A and measles to immunize under-five year old children.
Health promoters play a leading role in mobilizing resources, advocating for support from stakeholders, community leaders and the community itself. Health promoters as members of the rapid response teams at district level, coordinate the health information, and material distribution while at national level the health education unit engages multimedia to support health information dissemination at district level.
The research study, published in the Journal of Public Health in Africa, acknowledges that limited resources such as transport and financial resources is a major challenge affecting health education and promotion activities across the country.
“Health educators are limited when it comes to travelling to reach communities as well as financing health promotion activities. In most cases there is no specific budget for health education and promotion activities at district level. Programmes such as TB, HIV/AIDS, PMTCT are allocated a very small health education budget”, laments the study adding that “these budgets are then managed and controlled by clinicians and hence end up giving priority to curative services”.
It is further decried that lack of community-based media platforms such as community or district radio and television stations limit multimedia campaigns as all government and private organizations compete for slots in the government run media houses.
Health education n material development remains centralized at national level. This hinders the district health educations officers from developing education materials that best suit the culture and problems in their specific districts.
Professional development and identity remain a problem area. Since the inception of the professional body in 1998 health education officers have not fully developed the association to full-fledged professional body that can stand the professional needs and aspirations of health education officers.
“A staggering health education and promotion professional body is not only a challenge but a threat to the integrity of the profession and officers. In the year 1998 to 2002 the intake of health educators was temporarily suspended at the Gaborone Institute of Health Sciences for no clear justifiable reasons and the professional body did very little to advocate for the re-opening of the programme until government took a decision to open it again”, bemoans the research study adding that “despite the challenges, health education and promotion remains the pillar of primary health care in Botswana.”
